Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Sunshine Health Dual Align (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Sunshine Health Dual Align (HMO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Sunshine Health Dual Align (HMO D-SNP) is a HMO D-SNP plan offered by Centene Corporation available for enrollment in 2026 to people living in Select counties in FL. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare Sunshine Health Dual Align (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Sunshine Health Dual Align (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Below are a few key facts and commonly-asked questions about Wellcare Sunshine Health Dual Align (HMO D-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Wellcare Sunshine Health Dual Align (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
The Wellcare Sunshine Health Dual Align (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 6 select care drugs, you will pay no copay regardless of whether you use a preferred pharmacy, standard pharmacy, or mail order. Tier 1 preferred generic drugs are highly affordable, costing as little as a $1 copay for a one-month supply at preferred pharmacies, or no copay for a three-month supply through preferred mail order. Tier 2 generic drugs also offer no copay for a three-month preferred mail order, while Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacy options. Non-preferred drugs in Tier 4 carry a $100 copay for a one-month supply, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. This structure helps you choose the most cost-effective pharmacy and mail-order options to manage your prescription costs.
The Wellcare Sunshine Health Dual Align (HMO D-SNP) offers comprehensive medical coverage with a focus on affordable out-of-pocket costs. For inpatient stays, members pay a flat copayment of $2,225 for acute care or $2,080 for psychiatric care per admission, both with no coinsurance. Most outpatient services, specialist visits, diagnostic tests, and medical equipment require no copay and a standard 20% coinsurance, while primary care visits and home health services feature no copay and no coinsurance. This plan also provides valuable supplemental benefits to support overall wellness, including preventive dental, annual physicals, and fitness programs with no copay and no coinsurance. Additionally, members can access routine vision and hearing benefits, which include allowances for eyewear and prescription hearing aids with no copay, alongside up to 36 free one-way transportation trips per year to approved locations. Over-the-counter items and chronic illness meals are also fully covered with no copay and no coinsurance.
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers inpatient hospital services, excluding upgrades, additional days, and non-Medicare-covered stays. Covered acute inpatient stays require a $2,225 copayment per admission with no coinsurance, while psychiatric inpatient stays require a $2,080 copayment per admission with no coinsurance, with both services requiring prior authorization and referrals.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and referrals are required for most of these medical services.
Partial hospitalization is covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both featuring no coinsurance and copay waivers if admitted within 24 hours. Worldwide emergency and urgent care are partially covered with a $115 copay and no coinsurance up to a $50,000 limit, but worldwide emergency transportation is not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) primary care benefits are partially covered, as podiatry and other chiropractic services are not covered. Covered primary care physician services require no copay and no coinsurance, while specialist, therapy, and mental health services require no copay and 20% coinsurance.
Preventive services under the Wellcare Sunshine Health Dual Align (HMO D-SNP) are partially covered, featuring annual physical exams, fitness benefits, and alternative therapies with no copay and no coinsurance. Other services, such as kidney disease education, glaucoma screenings, and diabetes self-management training, require a referral and have a 20% coinsurance with no copay, while benefits like health education and nutritional programs are not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) offers partially covered hearing services with no deductible, including fitting evaluations and prescription hearing aids (up to $1,500 per ear yearly) for no copay or coinsurance, though routine exams require a 20% coinsurance. Prior authorization is required for exams and prescription aids, and OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision services are partially covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) because other eye exam services are not covered. With no deductibles, the plan covers one routine eye exam annually with no copay and 20% coinsurance, plus up to $300 yearly for eyewear with no copay or coinsurance for glasses, and no copay and 20% coinsurance for contact lenses.
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance. Preventive and most comprehensive dental services are covered with no copay and no coinsurance, though prior authorization is required, and maxillofacial prosthetics and orthodontics are not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and a 20% coinsurance, and a referral is required to receive care.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers diagnostic and radiological services with no copay, subject to a 20% coinsurance for all diagnostic procedures, lab services, and X-rays. Prior authorization and referrals are required for these covered medical services.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac rehabilitation services are covered by Wellcare Sunshine Health Dual Align (HMO D-SNP) with no copay and a required referral, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Wellcare Sunshine Health Dual Align (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral, but without requiring a prior three-day hospital stay. There is no copay for days 1 to 20 and 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the standard Medicare-covered limit are not covered.
Wellcare Sunshine Health Dual Align (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires a referral.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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